Robotic-Assisted Knee Arthroplasty (RAKA): The Technique, the Technology and the Transition

Abstract

Background: There has been an exponential increase in knee arthroplasty over the past 20 years. This has led to a quest for improvement in outcomes and patient satisfaction. While the last decade of last century proved to be the decade for Computer-Assisted Surgery (CAS) or Computer Navigation wherein the technology demonstrated a clear benefit in terms of improving mechanical axis alignment and component positioning, this decade is likely to belong to Robotics. Robotics adds an independent dimension to the benefits that CAS offers. The article deals with the generation of robots, technical steps in robotics, advantages and downsides of robotics and way forward in the field of knee arthroplasty.

Materials and methods: The review article was designed and edited by six different authors reviewing 32 relevant pubmed-based articles related to robotics in arthroplasty and orthopaedics. The concept, design and the definition of the intellectual content were based on the internationally published literature and insightful articles. The review is also based on the clinical experimental studies published in the literature.

Discussion: The robotic arm is actively involved with surgeon to achieve the precision and outcomes that the surgeon aims for. With the concept of haptic boundaries and augmented reality being incorporated in most systems, Robotic Assisted Arthroplasty (RAA) is likely to offer several advantages. The potential advantages of these systems may include accuracy in gap balancing, component positioning, minimal bone resection, reduced soft tissue handling and trauma, patient anatomy specific resection, and real time feedback. They, however, come with their own downsides in terms of capital cost, learning curve, time consumption and unclear advantages in term of long-term clinical outcomes.

Conclusion: To conclude, this review article offers a balanced view on how the technology is impacting current arthroplasty practice and what can be expected in coming years. The commitment of almost all major implant manufacturers in investing in robotics likely means that the evolution of Robotic technology and this decade will be exciting with rapid strides revealing paradigm shift and evolution of technology with significant reductions of cost enabling it to be available universally. For technology to populate in operating room, I think it will be result of exposure of young surgeons to these computers and robotics, as they grow in with confidence with technology from residency days to offer better precision in future.

Keywords: Alignment; Component positioning; Computer assisted surgery (CAS); Knee arthroplasty; Robotic arthroplasty; Robotic surgery; Robotic-assisted knee arthroplasty (RAKA); UKR.

Fig. 1

Key steps in robotic arthroplasty

Fig. 2

Registration of tibial side

Fig. 3

Registration of femoral side

Fig. 4

Creation of virtual femoral model

Fig. 5

Plan verification by the surgeon

Fig. 6

Guided cuts, component positioning and gap balancing in extension

Fig. 7

Guided cuts, component position and gap balancing in flexion

Fig. 8

Registration of the bone and cutting tool

Fig. 9

Haptic boundary creation